Improving outcomes in patients with resectable pancreatic cancer

Roberts, Keith

doi:10.1002/bjs.10692

Cited by 12 publications

(9 citation statements)

References 19 publications

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“…Optimizing pathways, reducing variation in practice, and national guidance can all help achieve improvement. While more substantial improvements may occur from novel chemotherapeutics, it is clear that outcomes and patient experience can be improved by focusing on optimizing every part of the patient pathway, from diagnosis to treatment [36]. It is therefore essential that current practice and its variation and effect on patient outcomes are evaluated.…”

Section: Discussionmentioning

confidence: 99%

Receipt of Curative Resection or Palliative Care for Hepatopancreaticobiliary Tumours (RICOCHET): Protocol for a Nationwide Collaborative Observational Study

2019

JMIR Res Protoc

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Background There are variations in the management of patients with suspected pancreatic and periampullary cancers and/or malignant biliary obstruction. These differences may be due to a number of organizational, institutional, and patient factors that could affect outcomes for those with curable or incurable disease. The Receipt of Curative Resection or Palliative Care for Hepatopancreaticobiliary Tumours (RICOCHET) study will be the first to provide a snapshot of investigative pathways across the United Kingdom to reflect the real-world practice in these patients. The RICOCHET study is contemporary to new national and international clinical guidance and can potentially inform future local and national strategic planning to optimize care for patients with suspected hepatopancreaticobiliary (HPB) malignancies. Objective The aim of this study is to define national variation in the investigative and management pathways of patients with suspected HPB malignancies and to determine the effect of these variations on patient outcomes. Methods The RICOCHET study is a nationwide, multicenter, prospective study. It is led by trainees through collaboration between surgical and medical specialties. Patients with suspected pancreatic cancer, other periampullary cancer, or extrahepatic cholangiocarcinoma presenting to hospitals in the United Kingdom will be identified over 90 days. Each case will be followed up for 90 days to collect data on the mode of presentation, investigations, interventions, use of local and specialist multidisciplinary team meetings, and transfer of care between hub and spoke sites. Furthermore, the study will define dates and intervals between key points in the patient pathway. Results The RICOCHET study results and analyses will be subject to peer review by presenting them at international cross-specialty conferences and by submitting them for publication in open-access journals. Moreover, our findings will be presented to patient groups and sponsoring charities (eg, Pancreatic Cancer UK), who in turn will disseminate key findings to the primary beneficiaries of the results: the patients. The RICOCHET study was funded in September 2017. Data collection started in April 2018 and the planned end date for data upload is spring 2019. Data analysis will take place in the summer of 2019 and the first results are expected to be published in late 2019 or early 2020. Conclusions The RICOCHET study is a multidisciplinary, prospective, observational study that aims to highlight variability in practice and to determine whether these affect the outcomes of patients with HPB malignancies. This is a trainee-led initiative that utilizes a novel design to achieve full coverage of the differences in diagnostic and management pathways. The RICOCHET study may provide evidence to develop a more standardized approach to managing patients with suspected HPB malignancy. Internatio...

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Section: Discussionmentioning

confidence: 99%

Receipt of Curative Resection or Palliative Care for Hepatopancreaticobiliary Tumours (RICOCHET): Protocol for a Nationwide Collaborative Observational Study

2019

JMIR Res Protoc

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“…Despite advances in diagnostic methods, operative techniques and perioperative management over the past few decades, patients with pancreatic cancer have a poor prognosis, with a 5‐year survival rate of 8 per cent. Although surgical resection is the only treatment that offers long‐term survival in selected patients with resectable pancreatic cancer, up to 80 per cent of patients develop locoregional and/or distant recurrence after primary pancreatectomy with curative intent, and this may contribute to the poor prognosis.…”

Section: Introductionmentioning

confidence: 99%

Management of isolated recurrence after surgery for pancreatic adenocarcinoma

Kim

Song

Lee

et al. 2019

British Journal of Surgery

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Background: Recurrence of pancreatic cancer after primary pancreatectomy occurs in the vast majority of patients. The role of surgical treatment for recurrent pancreatic cancer is not well established. Methods: Patients who underwent primary pancreatectomy with curative intent from 2000 to 2014 at a single large-volume centre were evaluated retrospectively. CT or PET was used to select patients with an isolated recurrence. The clinicopathological features and survival outcomes were compared according to treatment modalities. Results: Of the 1610 patients with pancreatic cancer who underwent resection, 1346 (83⋅6 per cent) were diagnosed with recurrent pancreatic cancer. Recurrence was locoregional in 366 patients (27⋅2 per cent), distant multifocal in 251 (18⋅6 per cent), distant isolated in 188 (14⋅0 per cent), locoregional plus distant in 153 (11⋅4 per cent) and peritoneal seeding in 388 (28⋅8 per cent). Of the 1346 patients with recurrence, 197 (14⋅6 per cent) had isolated recurrence; of these, 48 (24⋅4 per cent of all isolated recurrences; 3⋅6 per cent of all recurrences) underwent resection. Median survival of the 197 patients after diagnosis of isolated recurrence was 14⋅7 months; it was longer in patients who underwent surgical resection than among those treated non-surgically (23⋅5 versus 12⋅0 months; P = 0⋅014). Multivariable analysis showed that chemotherapy and resection for recurrence were associated with better prognosis. Median survival after recurrence was longest in the 23 patients with isolated pulmonary recurrence (33⋅3 months). Survival after recurrence was better in patients who underwent resection of isolated recurrence in the remnant pancreas (median 28⋅0 versus 12⋅0 months, P = 0⋅010) and lung (median 36⋅5 versus 9⋅5 months; P = 0⋅010) than in those who did not undergo resection.Conclusion: Surgical resection may be considered an option for treatment of patients with isolated recurrent pancreatic cancer.

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“…Despite the challenges presented by pancreatic cancer, after decades of lack of improvement in very poor outcomes, there is now reason for cautious optimism 1 . Systematic improvements across pathways such as improved outcomes with surgery, strategies to treat borderline or locally advanced pancreatic cancer, multimodal chemotherapy and a focus upon improving the patient experience are some of the causes for this optimism 2 .…”

Section: Introductionmentioning

confidence: 99%